Claims adjudication

Claims adjudication” is a phrase used in the insurance industry to refer to the process of paying Medical claims submitted or denying them after comparing Medical claims to the benefit or coverage requirements.

Alpha Medical Billing Solution (ABS) provides high-quality claims adjudication services to insurance providers as well as third party administrators. Our have strong claim adjudicators are trained on multiple adjudication platforms and have comprehensive knowledge of US healthcare reimbursement Rules. We leverage this expertise and back it with a well-defined process and latest technology to ensure issues like unwanted claims, delayed claim execution, and duplicate claims do not impact the revenues of our clients.

 

Our Claims Adjudication

 

  • Adjudicating Check
  • Analyzing validity of claims with fraud detection
  • Cleaning duplicate claims
  • Establishing medical service provider type
  • Validating data against adjudicating engine
  • Commitment fully adjudicated claims

How Claims Adjudication Process Works

 

 

Types of Claims Adjudication

  • Adjudicating Check
  •  CMS 1500
  • Dental Claims
  • UB92 Or UB04
  • Vision Forms
  • Correspondence